No benefit seen with magnesium given after stroke
Magnesium given within 12 hours of acute stroke does not significantly reduce the chances of death or disability, say researchers, but may be of benefit in non-cortical strokes.
In an international double-blind trial, 2,386 patients with a clinical
diagnosis of stroke in the previous 12 hours were randomised to receive
either a bolus dose of 16mmol of magnesium sulphate solution infused
over 15 minutes, followed by a maintenance dose of 65mmol over 24 hours,
or placebo.
Death or disability at 90 days was not found to be reduced by magnesium
(odds ratio 0.95, 95 per cent confidence interval 0.80–1.13). Mortality
was slightly higher in the magnesium-treated group than in the placebo
group (hazard ratio 1.18, 0.97–1.42). Planned subgroup analysis
showed that poor outcomes were reduced in non-cortical strokes (odds
ratio 0.75, 95 per cent CI 0.58–0.97), although the researchers
say this finding was not anticipated and should be viewed with caution.
The authors suggest reasons why no effect of treatment was seen despite
animal studies and preliminary clinical trials suggesting a neuroprotective
effect of magnesium sulphate in stroke. These include there being an
insufficient sample size to exclude a small but clinically relevant effect,
or magnesium treatment being harmful in some patients, thus obscuring
beneficial effect in others (Lancet 2004;363:439). |
The
Pharmaceutical Journal